Success of primary PCI is defined by different yardsticks by different cardiologists , in different institutions ! But , for the patient and his family, getting discharged alive with out symptoms is a huge success !
They do not bother even if they are charged Rs 3-4 lakh for their stay , as they believe surviving a heart attack is a God’s grace rendered thorough the hands of the doctor.
But we know the real success lies elsewhere. Cardiologist’s perception of success of pPCI should be based on scientific concepts. Unfortunately many physicians continue to think like their patients . This tendency to get self gratification with a patient’s frame of mind is common and needs introspection .
This is esepcailly true for primary PCI . It came with big fanfare a decade ago . Soon ,many cardiologists developed a habit of criticizing the practice thrombolysis for STEMI .If primary PCI is such a superior modality every patient should be prevented from significant myocardial damage following STEMI .
Primary PCI may be the the most logical method still , for reverting the STEMI process . But “A properly performed primary PCI as a concept ” lies mainly on paper , not been replicated in real world for various reasons.
Please remember , a successful primary PCI
- Is not restoring TIMI 3 flow in IRA
- Is not relieving the angina
- Is not discharging a patient in stable condition
Even if . . . we accomplish each one of the above . . . if the patient carries home anything equal to , or more than moderate LV dysfunction , primary PCI has deemed to have failed.
Final message
What is the reality check ? In one of the preliminary analysis out of 20 randomly selected patients who have undergone STEMI* within 12 hours , significant LV dysfunction was present in 12 patients making it pPCI only 40 % successful in real world .( Which would struggle to beat the outcome of promptly administered fibrinolysis )
* Primary PCI done in state of the art institutes .
Dr.S.Venkatesan MD 